PGA CARS INC. - AUTHORITY TO DEDUCT

1
* This field is required.
Please Select
Please Select
Cellphone Billing
Lifestyle Items
LTO Renewal
Insurance Policy
Others
2
Description* This field is required.
3
Name* This field is required.
4
Billing Month* This field is required.
5
SOA / Billing No. / Account No.* This field is required.
6
Amount* This field is required.
7
Deduction Option* This field is required.
Please Select
Please Select
salary
commissions
other remuneration due from the company
8
Terms* This field is required.
Please Select
Please Select
Lump sum
Semi-monthly installments
9
Terms* This field is required.
Please Select
Please Select
2
3
4
5
6
12
10
Lump Sum effectivity date* This field is required.
Date
Year
Month
Day
11
Semi-monthly installment amount* This field is required.
12
Installment effectivity date* This field is required.
13
Invoice No./IDN/PSI* This field is required.
14
Plate No. / Conduction Sticker No.* This field is required.
15
Insurance Policy No.* This field is required.
16
Should be Empty: